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WHO warns of oxygen shortage as COVID cases set to 10 million

The world faces a shortage of oxygen concentrators as the number of worldwide cases of coronavirus infection nears the 10 million. COVID-19 Tracker ›

“Many countries are now experiencing difficulties obtaining oxygen concentrators,” WHO Director General Tedros Adhanom Ghebreyesus told a news conference. “Demand is currently outstripping supply.”

The sudden rise has created a dearth of oxygen concentrators needed to support breathing of COVID-19 patients suffering from respiratory distress.

The health agency has purchased 14,000 oxygen concentrators from manufacturers and plans to send them to 120 countries in coming weeks, Tedros said. A further 170,000 concentrators – valued at some $100 million – will be potentially available over the next six months.

The head of the WHO emergencies programme, Dr Mike Ryan, meanwhile said the pandemic in many Latin American countries was still intense as deaths in the region surpassed 100,000 this week. Many countries had experienced 25-50% increases in cases in the past week, he said.

Source: Reuters

Gilead prices Remdesivir at $2,340 for a five-day treatment

Gilead Sciences Inc has priced its COVID-19 drug candidate remdesivir at $2,340 for a five-day treatment in the United States and some other developed countries, potentially reflecting looming competition from a cheap steroid.

Remdesivir is at the forefront of the fight against COVID-19 after the anti-viral treatment helped shorten hospital recovery times in a clinical trial. It has been approved for emergency use in some patients in the United States.

The remdesivir price for U.S. private insurance companies will be $520 per vial, Gilead said, which equates to $3,120 per patient for a treatment course of six vials.

Gilead has linked up with generic drugmakers based in India and Pakistan, including Cipla Ltd and Hetero Labs Ltd, to make and supply remdesivir in 127 developing countries.

Cipla’s version is priced at less than 5,000 Indian rupees ($66.24), while Hetero Lab’s version is priced at 5,400 rupees.

Source: Medscape

FDA approves atezolizumab + bevacizumab for advanced HCC

The US Food and Drug Administration (FDA) has approved Tecentriq® (atezolizumab) in combination with Avastin® (bevacizumab) for the treatment of people with unresectable or metastatic hepatocellular carcinoma (HCC) who have not received prior systemic therapy.

Atezolizumab is a monoclonal antibody designed to bind with a protein called PD-L1, which is expressed on tumour cells and tumour-infiltrating immune cells, blocking its interactions with both PD-1 and B7.1 receptors. By inhibiting PD-L1, it may enable the activation of T-cells.

Bevacizumab is a biologic antibody designed to specifically bind to a protein called VEGF that plays an important role throughout the lifecycle of the tumour to develop and maintain blood vessels, a process known as angiogenesis. It is designed to interfere with the tumour blood supply by directly binding to the VEGF protein to prevent interactions with receptors on blood vessel cells. The tumour blood supply is thought to be critical to a tumour’s ability to grow and spread in the body (metastasis).

Source: Roche, fda.gov

Hydroxychloroquine Sulfate (HCQ)

Rx Prescription Required

Classes: Aminoquinoline, Antimalarials, DMARDs, Immunosuppressants, Cytochrome P-450 CYP2D6 Inhibitors

Uses: Uncomplicated malaria, rheumatoid arthritis, chronic discoid lupus erythematosus, systemic lupus erythematosus, COVID-19*

Administration: Oral (Take with a meal or a glass of milk)

Dosages ›
Interactions ›
Adverse Effects ›
Warnings ›
Safety Advice ›
Pharmacology ›
General Considerations ›
Monitoring Parameters ›

Auto Q 200mg Tablet

Manufacturer: Regenix Drugs Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 60.25 (10 tablets in 1 strip) ₹6.02/Tablet

Axemal Tablet

Manufacturer: Obsurge Biotech Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 64.95 (10 tablets in 1 strip) ₹6.49/Tablet

Bioquin 200mg Tablet

Manufacturer: Ipca Laboratories Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 68 (10 tablets in 1 strip) ₹6.8/Tablet

Cartiquin 200mg Tablet

Manufacturer: Overseas Healthcare Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 65.4 (10 tablets in 1 strip) ₹6.5/Tablet

Cartiquin 300mg Tablet

Manufacturer: Overseas Healthcare Pvt Ltd

Salt Composition: Hydroxychloroquine (300mg)

Price: Rs 132.5 (10 tablets in 1 strip) ₹13.2/Tablet

Cartiquin 400mg Tablet

Manufacturer: Overseas Healthcare Pvt Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 107.7 (10 tablets in 1 strip) ₹10.7/Tablet

CoviQ Tablet

Manufacturer: Zydus Cadila

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 55.9 (10 tablets in 1 strip) ₹5.59/Tablet

Chloro QS 200mg Tablet

Manufacturer: Cmg Biotech Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 69.5 (10 tablets in 1 strip) ₹6.95/Tablet

Deng 200mg Tablet

Manufacturer: East West Pharma

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 57.75 (10 tablets in 1 strip) ₹5.7/Tablet

Dmd 200mg Tablet

Manufacturer: Zoic Lifesciences

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 59 (10 tablets in 1 strip) ₹5.9/Tablet

Dxq 200mg Tablet

Manufacturer: Nahren Lifesciences

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 62.2 (10 tablets in 1 strip) ₹6.2/Tablet

Dxq 300mg Tablet

Manufacturer: Nahren Lifesciences

Salt Composition: Hydroxychloroquine (300mg)

Price: Rs 115 (10 tablets in 1 strip) ₹11.5/Tablet

Era-H 200mg Tablet

Manufacturer: TBG pharma ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 62 (10 tablets in 1 strip) ₹6.2/Tablet

Had Q 200mg Tablet

Manufacturer: UHC Life Sciences

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 65.45 (10 tablets in 1 strip) ₹6.54/Tablet

HCQS 200 Tablet

Manufacturer: Ipca Laboratories Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 99.29 (15 tablets in 1 strip) ₹6.62/Tablet

HCQS 300 Tablet

Manufacturer: Ipca Laboratories Ltd

Salt Composition: Hydroxychloroquine (300mg)

Price: Rs 152.95 (10 tablets in 1 strip) ₹15.29/Tablet

HCQS 400 Tablet

Manufacturer: Ipca Laboratories Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 133 (10 tablets in 1 strip) ₹13.34/Tablet

Hikem Tablet

Manufacturer: Bioceutics Inc

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 70 (10 tablets in 1 strip) ₹7/Tablet

HQ 200mg Tablet

Manufacturer: Vasu Organics Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 55 (10 tablets in 1 strip) ₹5.5/Tablet

HQ 400mg Tablet

Manufacturer: Vasu Organics Pvt Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 10.3 (10 tablets in 1 strip) ₹10/Tablet

Hqra 200mg Tablet

Manufacturer: Rhumasafe Pharmaceutical

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 62 (10 tablets in 1 strip) ₹6.2/Tablet

Hqra 300mg Tablet

Manufacturer: Rhumasafe Pharmaceutical

Salt Composition: Hydroxychloroquine (300mg)

Price: Rs 110 (10 tablets in 1 strip) ₹11/Tablet

Hqra 400mg Tablet

Manufacturer: Rhumasafe Pharmaceutical

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 120 (10 tablets in 1 strip) ₹12/Tablet

Hqtor Tablet

Manufacturer: Torrent Pharmaceuticals Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 64.9 (10 tablets in 1 strip) ₹6.49/Tablet

Hqtor 400 Tablet

Manufacturer: Torrent Pharmaceuticals Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 130 (10 tablets in 1 strip) ₹13/Tablet

H-Quine 200mg Tablet

Manufacturer: Ankaa Pharmaceutical

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 58 (10 tablets in 1 strip) ₹5.8/Tablet

Hqwin 200mg Tablet

Manufacturer: Orsim Pharma

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 59 (10 tablets in 1 strip) ₹5.9/Tablet

Hydrocad 200mg Tablet

Manufacturer: Cadila Pharmaceuticals Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 60.48 (10 tablets in 1 strip) ₹60/Tablet

Hydroquin 200mg Tablet

Manufacturer: Sun Pharmaceutical Industries Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 60 (10 tablets in 1 strip) ₹6/Tablet

Hydroquin 400mg Tablet

Manufacturer: Sun Pharmaceutical Industries Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 125 (10 tablets in 1 strip) ₹12.5/Tablet

Hydrowin 200mg Tablet

Manufacturer: Ikon Remedies Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 59.22 (10 tablets in 1 strip) ₹5.92/Tablet

Hydrowin 400mg Tablet

Manufacturer: Ikon Remedies Pvt Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 106.26 (10 tablets in 1 strip) ₹10.6/Tablet

HYQ 400 Tablet

Manufacturer: Ipca Laboratories Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 133 (10 tablets in 1 strip) ₹13.34/Tablet

Imulast 200mg Tablet

Manufacturer: Cipla Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 65.8 (10 tablets in 1 strip) ₹6.5/Tablet

Imulast 400mg Tablet

Manufacturer: Cipla Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 125 (10 tablets in 1 strip) ₹12.5/Tablet

Kaiquin 200mg Tablet

Manufacturer: Kaizen Research Labs India Pvt Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 51 (10 tablets in 1 strip) ₹5.1/Tablet

Ketor 200mg Tablet

Manufacturer: Chemo Healthcare Pvt Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 60 (10 tablets in 1 strip) ₹6/Tablet

Latvitor 200 Tablet

Manufacturer: Osiante Biotech

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 90.38 (15 tablets in 1 strip) ₹6.03/Tablet

Mcqs 200mg Tablet

Manufacturer: Molekule India Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 69.9 (10 tablets in 1 strip) ₹6.99/Tablet

Nid-Q 200mg Tablet

Manufacturer: Nidus Pharma Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 56 (10 tablets in 1 strip) ₹5.6/Tablet

Numi HQ 200mg Tablet

Manufacturer: Nusmith Pharma Pvt. Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 67.5 (10 tablets in 1 strip) ₹6.75/Tablet

Orthokind 200mg Tablet

Manufacturer: Mankind Pharma Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 69.9 (10 tablets in 1 strip) ₹6.99/Tablet

Oxcq 200 Tablet

Manufacturer: Wallace Pharmaceuticals Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 66.14 (10 tablets in 1 strip) ₹6.61/Tablet

Oxcq 300 Tablet

Manufacturer: Wallace Pharmaceuticals Pvt Ltd

Salt Composition: Hydroxychloroquine (300mg)

Price: Rs 111.87 (10 tablets in 1 strip) ₹11/Tablet

P Hyd 200mg Tablet

Manufacturer: Parry Pharma Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 60 (10 tablets in 1 strip) ₹6/Tablet

Paxoquin 200mg Tablet

Manufacturer: Pax Healthcare

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 68 (10 tablets in 1 strip) ₹6.8/Tablet

Plaquenil

Manufacturer: Sanofi‐Synthelabo Inc

Salt Composition: Hydroxychloroquine (200mg)

Price: $96.38 (30 tablets in 1 strip) 

Qcq 200mg Tablet

Manufacturer: Femgrace Formulations

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 62.5 (10 tablets in 1 strip) ₹6.25/Tablet

Qdmrd 200 Tablet

Manufacturer: Alembic Pharmaceuticals Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 64.92 (10 tablets in 1 strip) ₹6.49/Tablet

Qdmrd 400 Tablet

Manufacturer: Alembic Pharmaceuticals Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 126 (10 tablets in 1 strip) ₹12.6/Tablet

Qslera 200mg Tablet

Manufacturer: Renauxe Pharma India Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 60 (10 tablets in 1 strip) ₹6/Tablet

Qurion 200mg Tablet

Manufacturer: Ernst Pharmacia

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 90.39 (15 tablets in 1 strip) ₹6.03/Tablet

Qyn 200mg Tablet

Manufacturer: FDC Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 58.4 (10 tablets in 1 strip) ₹5.84/Tablet

Q-Rado 400mg Tablet

Manufacturer: El-Dorado Bio-Tech Pvt Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 94.3 (10 tablets in 1 strip) ₹9.4/Tablet

Racq 200mg Tablet

Manufacturer: Doctors Choice Health Care India Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 93 (15 tablets in 1 strip) ₹6.2/Tablet

Ra Quin 200mg Tablet

Manufacturer: Sun Pharmaceutical Industries Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 67.5 (10 tablets in 1 strip) ₹6.7/Tablet

Rarex 200mg Tablet

Manufacturer: Molekule India Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 56.4 (10 tablets in 1 strip) ₹5.6/Tablet

Rhq 200mg Tablet Discontinued

Manufacturer: Abbott Laboratories

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 60.48 (10 tablets in 1 strip) ₹6.04/Tablet

RHQ 400mg Tablet Discontinued

Manufacturer: Abbott Laboratories

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 114 (10 tablets in 1 strip) ₹11/Tablet

Riva QS 200mg Tablet

Manufacturer: Achilles Healthcare Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 97 (15 tablets in 1 strip) ₹6.47/Tablet

Rumawill 200mg Tablet

Manufacturer: Mediwill Life Sciences

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 56 (10 tablets in 1 strip) ₹5.6/Tablet

Rutor 200mg Tablet

Manufacturer: Chemo Biological

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 80 (10 tablets in 1 strip) ₹8/Tablet

Vohq 200mg Tablet

Manufacturer: Vasu Organics Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 64.9 (10 tablets in 1 strip) ₹6.49/Tablet

Vohq 400mg Tablet

Manufacturer: Vasu Organics Pvt Ltd

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 118.65 (10 tablets in 1 strip) ₹11.8/Tablet

Winflam 200mg Tablet

Manufacturer: Micro Labs Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 65 (10 tablets in 1 strip) ₹6.5/Tablet

Yadrox 200mg Tablet

Manufacturer: Trireme Life Sciences Pvt Ltd

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 62.5 (10 tablets in 1 strip) ₹6.25/Tablet

Ydro 200mg Tablet

Manufacturer: Arvincare Pharma

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 62.5 (10 tablets in 1 strip) ₹6.25/Tablet

Ydro 400mg Tablet

Manufacturer: Arvincare Pharma

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 160 (10 tablets in 1 strip) ₹16/Tablet

Zhquine 200mg Tablet

Manufacturer: Ambience Pharma

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 56.3 (10 tablets in 1 strip) ₹5.63/Tablet

Zhquine 400mg Tablet

Manufacturer: Ambience Pharma

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 112 (10 tablets in 1 strip) ₹11.2/Tablet

Zy-Q 200 Tablet

Manufacturer: Zydus Cadila

Salt Composition: Hydroxychloroquine (200mg)

Price: Rs 167.87 (30 tablets in 1 bottle) ₹5.6/Tablet

Zy-Q 300 Tablet

Manufacturer: Zydus Cadila

Salt Composition: Hydroxychloroquine (300mg)

Price: Rs 425.1 (30 tablets in 1 strip) ₹14.17/Tablet

Zy-Q 400 Tablet

Manufacturer: Zydus Cadila

Salt Composition: Hydroxychloroquine (400mg)

Price: Rs 392.72 (30 tablets in 1 strip) ₹13.09/Tablet

No drug combination found

Dosages

Rheumatoid Arthritis

  • Oral dose: 400 mg OD dose or in 2 divided doses 200mg BD, with or without concomitant non-biologic disease-modifying antirheumatic drugs  
  • Maintenance: 300 mg OD (usually after 3 months of initial dosing) and continue maintenance dose of 200-400 mg/day (155-310 mg base/day) PO as a qDay or in BID; not exceed 600 mg or 6.5 mg/kg (5 mg/kg base) per day due to the risk of retinal toxicity

Coronavirus disease 2019 (COVID-19) Treatment

  • Oral Initial dose: 400 mg BID, for 1 day in combination with azithromycin
  • Maintenance dose: 200 mg BID, for 4 days
  • In patients with severe disease and requiring ICU management (MoHFW India, March 2020). It should be administered under close medical supervision, with monitoring for side effects, including QTc interval prolongation. Not recommended in pregnant and lactating women

Coronavirus disease 2019 (COVID-19) Prophylaxis (ICMR 22 May 2020)

  • Oral Initial dose: 400 mg BID, on day 1
  • Maintenance dose: 400 mg once weekly for the next 7 weeks, taken with a meal
  • Asymptomatic healthcare workers involved in containment and treatment  of COVID-19 or working in non-COVID hospitals/non-COVID areas of COVID hospitals/blocks as well as asymptomatic frontline workers deployed in containment zones and paramilitary/police personnel involved in COVID-19 related-activities

Coronavirus disease 2019 (COVID-19) Prophylaxis for Asymptomatic household contacts of laboratory-confirmed cases

  • Oral Initial dose: 400 mg BID, on day 1
  • Maintenance dose: 400 mg once weekly for the next 3 weeks taken with meals

Malaria Prophylaxis

  • Oral dose: 400 mg (310 mg base) PO weekly, starting 2 weeks before exposure and continued for 4 weeks after departure from endemic area OR
  • Weight-based dosing: 6.5 mg/kg (5 mg/kg base) PO once weekly, not to exceed 400 mg (310 mg base), starting 2 weeks before exposure and continued for 4 weeks after leaving the endemic area

Acute treatment for Uncomplicated Malaria due to P falciparum, P malariae, P ovale, and P viva

  • Oral dose: 800 mg (620 mg base) OD, then 400 mg (310 mg base) OD at 6 hr, 24 hr, and 48 hr after initial dose OR
  • Weight-based dosing: 13 mg/kg (10 mg/kg base), not to exceed 800 mg (620 mg base) followed by 6.5 mg/kg (5 mg/kg base), not to exceed 400 mg (310 mg base), PO at 6 hr, 24 hr, and 48 hr after initial dose

Systemic Lupus Erythematosus

  • Oral dose: 200-400 mg/day (155-310 mg base/day) OD as a single daily dose or in two divided doses
  • Doses >400 mg/day are not recommended. Incidence of retinopathy has been reported to be higher when this maintenance dose is exceeded

Porphyria cutanea tarda (off-label use)

  • Oral dose: 100 mg twice weekly continue until plasma porphyrin levels are normal for at least one month

Primary Sjögren syndrome (extra-glandular manifestations) (off-label use)

  • Oral dose: 200–400 mg OD, or in two divided doses
  • Due to the risk of retinal toxicity, do not exceed a daily dose of 5 mg/kg/day using actual body weight or 400 mg

Q fever, chronic (off-label use)

  • Oral dose: 600 mg/day in 1 or 3 divided doses in combination with doxycycline for ≥18 months depending on site of infection and serologic response

Prevention of persistent infection following acute Q fever

  • Oral dose: 600 mg/day in 1 or 3 divided doses in combination with doxycycline for 12 months

Lupus erythematosus (off-label dose)

  • Oral dose: 200–400 mg OD or in 2 divided doses

Juvenile rheumatoid arthritis (JRA) or systemic lupus erythematosus (SLE)

  • Oral dose: 3–5 mg/kg/day divided 1–2 times/day to a maximum of 400 mg/day, not to exceed 7 mg/kg/day

Coronavirus disease 2019 (COVID-19) Treatment for adolescents >12 years with severe disease and requiring ICU management (MoHFW India, March 2020)

  • Oral Initial dose: 400 mg BID, for 1 day in combination with azithromycin
  • Maintenance dose: 200 mg BID, for 4 days
  • Should be administered under close medical supervision, with monitoring for side effects, including QTc interval prolongation

Acute attack of Uncomplicated Malaria treatment for Infants, children, and adolescents

  • Oral dose: 13 mg/kg/dose (maximum initial dose: 800 mg/dose), followed by 6.5 mg/kg at 6, 24, and 48 hours after the initial dose (maximum dose: 400 mg/dose)

Malaria Chemoprophylaxis for Infants, children, and adolescents

  • Oral dose: 6.5 mg/kg once weekly on the same day each week; maximum dose: 400 mg/dose, begin 1–2 weeks  before exposure 
  • Continue for at least 4 weeks after leaving the endemic area 
  • If the initiation of chemoprophylaxis is delayed (i.e. 2 weeks of therapy not completed prior to the exposure), initiate therapy by doubling the initial dose (13 mg/kg) and administering in 2 divided doses 6 h apart; maximum single dose: 400 mg/dose; continue for 8 weeks after leaving the endemic area

Interactions

Contraindicated

  • lefamulin

Serious

  • adalimumab
  • alefacept
  • alfuzosin
  • amiodarone
  • amitriptyline
  • amoxapine
  • anakinra
  • anthrax vaccine
  • antithymocyte globulin equine
  • antithymocyte globulin rabbit
  • apomorphine
  • arformoterol
  • arsenic trioxide
  • artemether/lumefantrine
  • asenapine
  • azathioprine
  • azithromycin
  • basiliximab
  • BCG vaccine live
  • bedaquiline
  • canakinumab
  • chlorpromazine
  • ciprofloxacin
  • cisapride
  • citalopram
  • clarithromycin
  • clofazimine
  • clomipramine
  • clozapine
  • crizotinib
  • cyclosporine
  • dapsone topical
  • dasatinib
  • degarelix
  • desipramine
  • deutetrabenazine
  • digoxin
  • diphtheria & tetanus toxoids/acellular pertussis/poliovirus, inactivated vaccine
  • disopyramide
  • dofetilide
  • dolasetron
  • dronedarone
  • droperidol
  • encorafenib
  • entrectinib
  • eribulin
  • erythromycin base
  • erythromycin ethylsuccinate
  • erythromycin lactobionate
  • erythromycin stearate
  • escitalopram
  • etanercept
  • everolimus
  • ezogabine
  • flecainide
  • fluconazole
  • fluoxetine
  • fluphenazine
  • formoterol
  • foscarnet
  • gemifloxacin
  • gemtuzumab
  • glasdegib
  • glatiramer
  • golimumab
  • haloperidol
  • hepatitis A vaccine inactivated
  • hepatitis a/b vaccine
  • hepatitis a/typhoid vaccine
  • hepatitis b vaccine
  • human papillomavirus vaccine, nonavalent
  • human papillomavirus vaccine, quadrivalent
  • ibutilide
  • iloperidone
  • indacaterol (Inhaled)
  • indapamide
  • infliximab
  • influenza virus vaccine quadrivalent
  • influenza virus vaccine quadrivalent, intranasal
  • influenza virus vaccine trivalent
  • inotuzumab
  • isradipine
  • Japanese encephalitis virus vaccine
  • lapatinib
  • leflunomide
  • levofloxacin
  • lofexidine
  • lopinavir
  • maprotiline
  • measles (rubeola) vaccine
  • measles mumps and rubella vaccine, live
  • measles, mumps, rubella and varicella vaccine, live
  • mefloquine
  • meningococcal A C Y and W-135 polysaccharide vaccine combined
  • methadone
  • mifepristone
  • moxifloxacin
  • muromonab CD3
  • mycophenolate
  • nilotinib
  • nortriptyline
  • octreotide
  • ofloxacin
  • olanzapine
  • ondansetron
  • osimertinib
  • paliperidone
  • panobinostat
  • pasireotide
  • pazopanib
  • pentamidine
  • perphenazine
  • pimavanserin
  • pimozide
  • pitolisant
  • pneumococcal vaccine 13-valent
  • pneumococcal vaccine heptavalent
  • pneumococcal vaccine polyvalent
  • posaconazole
  • procainamide
  • propafenone
  • protriptyline
  • quetiapine
  • quinidine
  • quinine
  • rabies vaccine
  • rabies vaccine (chick embryo cell derived)
  • ranolazine
  • remdesivir
  • ribociclib
  • rilonacept
  • rilpivirine
  • risperidone
  • ritonavir
  • romidepsin
  • rotavirus oral vaccine, live
  • rubella vaccine
  • saquinavir
  • sertraline
  • sirolimus
  • smallpox vaccine (live)
  • solifenacin
  • sorafenib
  • sotalol
  • sunitinib
  • tacrolimus
  • telavancin
  • temsirolimus
  • tetanus toxoid adsorbed or fluid
  • tetrabenazine
  • thioridazine
  • thiothixene
  • tick borne encephalitis vaccine
  • tocilizumab
  • tofacitinib
  • tongkat ali
  • toremifene
  • travelers diarrhea and cholera vaccine inactivated
  • trimipramine
  • typhoid polysaccharide vaccine
  • typhoid vaccine live
  • ustekinumab
  • vandetanib
  • vardenafil
  • varicella virus vaccine live
  • vemurafenib
  • vilanterol/fluticasone furoate inhaled
  • voriconazole
  • vorinostat
  • yellow fever vaccine
  • ziprasidone
  • zoster vaccine live

Monitor Closely

  • astragalus
  • cholera vaccine
  • dengue vaccine
  • denosumab
  • echinacea
  • influenza virus vaccine quadrivalent, recombinant
  • influenza virus vaccine trivalent, recombinant
  • maitake
  • mercaptopurine
  • methotrexate
  • osilodrostat
  • ozanimod
  • selpercatinib
  • siponimod
  • sipuleucel-T
  • tobramycin inhaled
  • zoster vaccine recombinant

Minor

  • chloroquine
  • praziquantel

Adverse Effects

Frequency Not Defined

  • Blood and lymphatic system disorders: Bone marrow failure, anemia, aplastic anemia, agranulocytosis, leukopenia, and thrombocytopenia; hemolysis reported in individuals with glucose-6-phosphate dehydrogenase (G-6-PD) deficiency
  • Cardiovascular disorders: Cardiomyopathy, QT interval prolongation, and ventricular arrhythmias and torsade de pointes
  • Ear and labyrinth disorders: Vertigo, tinnitus, nystagmus, nerve deafness, deafness
  • Eye disorders: Irreversible retinopathy with retinal pigmentation changes (bull’s eye appearance), visual field defects (paracentral scotomas) and visual disturbances (visual acuity), maculopathies (macular degeneration), decreased dark adaptation, color vision abnormalities, corneal changes (edema and opacities) including corneal deposition of drug with or without accompanying symptoms (halo around lights, photophobia, blurred vision)
  • Gastrointestinal disorders: Nausea, vomiting, diarrhea, abdominal pain
  • Hepatobiliary disorders: Liver function tests abnormal, Acute hepatic failure
  • Immune system disorders: Urticaria, angioedema, bronchospasm
  • Metabolism and nutrition disorders: Decreased appetite, hypoglycemia, porphyria, weight decreased
  • Musculoskeletal and connective tissue disorders: Sensorimotor disorder, skeletal muscle myopathy or neuromyopathy leading to progressive weakness and atrophy of proximal muscle groups, depression of tendon reflexes and abnormal nerve conduction
  • Nervous system disorders: Headache, dizziness, seizure, ataxia and extrapyramidal disorders such as dystonia, dyskinesia, tremor
  • Psychiatric disorders: Affect/emotional lability, nervousness, irritability, nightmares, psychosis, suicidal behaviour
  • Skin and subcutaneous tissue disorders: Rash, pruritus, pigmentation disorders in skin and mucous membranes, hair color changes, alopecia; dermatitis bullous eruptions including erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS syndrome), photosensitivity, dermatitis exfoliative, acute generalized exanthematous pustulosis (AGEP)

Contraindications & Warnings

Contraindicated in

  • Hypersensitivity to HCQ and related components
  • Long-term use in children
  • Retinal or visual field changes due to similar compounds
  • Pre-existing cardiomyopathy and cardiac rhythm disorders
  • G6PD deficiency

Increased risk for

  • QT prolongation
  • Exacerbation of psoriasis
  • Retinal damage
  • Loss of visual acuity
  • Exacerbation of porphyria
  • Dermatitis outbreaks
  • Cardiomyopathy
  • Aplastic anaemia
  • Agranulocytosis
  • Myopathy
  • Suicidal behaviour
  • In patients with cardiovascular disorders
  • In patients with hepatic and renal impairment
  • In concomitant use with antidiabetic agent

Safety Advice

🍺   Alcohol: Caution

🤰🏻   Pregnancy: Category C

🤱🏻   Breastfeeding: Unsafe

🚗   Driving: Unsafe

 Kidney: Caution

 Liver: Caution

 

Pharmacology

Mechanism of Action

  • In Malaria: HCQ interfere with the digestive vacuole function within susceptible malarial parasites by increasing pH and interrupting with the lysosomal degradation of Hb, thereby impeding the normal cell function of sensitive parasites
  • In COVID-19: The antiviral activity of HCQ in COVID-19 might be exerted by changing the pH at the cell membrane surface and inhibiting viral fusion. It can also inhibit nucleic acid replication, glycosylation of viral proteins, as well as viral assembly and release
  • In Rheumatoid arthritis and systemic lupus erythematosus: Mechanisms underlying the anti-inflammatory and immunomodulatory effects of hydroxychloroquine are unknown

Pharmacokinetic

  • Bioavailability: Variable (74% on average); Tmax = 2–4.5 hours
  • Protein binding: 45%
  • Metabolism: Liver
  • Elimination half-life: 32–50 days
  • Excretion: Mostly kidney (23–25% as unchanged drug), also biliary (<10%)

Pharmacodynamics

  • Hydroxychloroquine affects the function of lysozomes in humans as well as plasmodia. 
  • Altering the pH of the lysozomes reduces low affinity self antigen presentation in autoimmue diseases and interferes with the ability of plasmodia to proteolyse hemoglobin for their energy requirements

General Considerations

  • Advise patients to take with food or milk
  • Alcohol must be avoided
  • Toxicity: Patients experiencing an overdose may present with headache, drowsiness, visual disturbances, cardiovascular collapse, convulsions, hypokalemia, rhythm and conduction disorders including QT prolongation, torsades de pointes, ventricular tachycardia, and ventricular fibrillation. This may progress to sudden respiratory and cardiac arrest. Overdose should be treated with immediate gastric lavage and activated charcoal at a dose of at least 5 times the hydroxychloroquine dose within 30 minutes. Parenteral diazepam may be given to treat cardiotoxicity, transfusion may reduce serum concentrations of the drug, patients should be monitored for at least 6 hours, fluids should be given, and ammonium chloride should be given to acidify urine and promote urinary excretion. Patients may also be given epinephrine. Patients with severe toxicity should be intubated and sedated with high doses of benzodiazepines, and circulatory support should be provided with fluids and vasopressors (e.g. epinephrine). Consider early intravenous lipid therapy for patients with ventricular dysrhythmias or hypotension. Orotracheal intubation for airway protection should be performed early in cases of severe psychomotor agitation, repeated seizure activity, coma, or evidence of severe quinidine-like cardiotoxicity

General Monitoring Parameters

  • ECG for estimation of QT interval
  • CBC at baseline with periodic tests for liver function, renal function, blood glucose level, and muscle strength during long-term therapy 
  • Ophthalmologic examination

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Major breakthrough in coronavirus treatment

Dexamethasone ‘Major Breakthrough’ in coronavirus treatment

Dexamethasone reduces deaths by up to a third in hospitalised patients with severe respiratory complications of COVID-19, the University of Oxford’s, UK randomised recovery trial has found.

“It is a major breakthrough,” Co-Chief Investigator, Peter Horby, professor of emerging infectious diseases in the Nuffield Department of Medicine, told a news briefing. “The results are sufficiently clear, we can announce the results today and people could be treated this evening or tomorrow.”

A total of 2104 patients were randomised to receive dexamethasone 6mg once per day by mouth or by intravenous injection for 10 days and were compared with 4321 patients randomised to usual care alone.

Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75; p=0.14). Government Chief Medical Adviser Professor Chris Whitty called it “the most important trial result for COVID-19 so far”.

The World Health Organization (WHO) also said that initial clinical trial results from Oxford University showed dexamethasone, a steroid, to be lifesaving for critically ill covid-19 patients.

Source: Medscape

Alpha-1-Antitrypsin (AAT) Test

Uses: Preferred test to identify alpha-1-antitrypsin deficiency and causative DNA and protein variants. Congenital deficiency of  Alpha-1-Antitrypsin is associated with early lung disease, Neonatal hepatitis and Infantile cirrhosis

Method: Nephelometry, Immunoturbidimetry, Polymerase Chain Reaction, Fluorescence Monitoring, Isoelectric Focusing, ELISA

Category: Genetic Disorders

Reference: Alpha-1-Antitrypsin Stool-Clearance: 1 – 49 mL/24h
Alpha-1-Antitrypsin, Quantitative by ELISA, Random Stool: 0.00 – 0.50 mg/g
Alpha-1-Antitrypsin: 90-200 mg/dL

Pre-test Information: No special preparation required

Specimen Collection: 2 mL (0.5 mL min.) serum from 1 Red tube. Do not use SST gel barrier tubes. Separate serum from cells immediately. Ship refrigerated or frozen or lavender (EDTA), pink (K2EDTA), or yellow (ACD Solution A or B) tube. 

Alpha-1-Antitrypsin Clearance, Quantitative by ELISA, Timed Stool: Entire 24-, 48-, or 72-hour stool collection. Refrigerate during collection. Collect blood during the stool collection time interval. Allow serum to clot completely at room temperature. Separate from cells ASAP or within 2 hours of collection

Storage: Frozen

Stability: Serum: Ambient: 1 week; Refrigerated: 3 months; Frozen: 3 months (avoid repeat freeze/thaw cycles)
Whole Blood: Ambient: 72 hours; Refrigerated: 2 weeks; Frozen: 1 month

Report Availability: Same day-10 days

More Details: Alpha-1-Antitrypsin (AAT) is a protease inhibitor which has the capacity to combine with and inactivate trypsin. It also neutralizes the activity of other proteases like elastase and hence is an intrinsic factor in the homeostatic mechanism modulating endogenous proteolysis. Deficiency of AAT is seen in Pulmonary emphysema and in children with Cirrhosis. At least 75 different alleles exist for AAT of which about 17 alleles are associated with pulmonary disease and only a few are responsible for liver disease. Elevated AAT levels are due to acute-phase reaction to inflammation and infections which is not linked to genetic defects. High values are also seen during pregnancy and on oral contraceptives

Ankit Bharat MD performs 1st lung transplant for COVID-19 patient

A woman in her 20s received a double-lung transplant last week after the coronavirus damaged her respiratory system, Northwestern Medicine in Chicago.

The woman spent 6 weeks in the hospital’s COVID ICU on a ventilator and life support. In early June, her lungs developed irreversible damage, and she was listed for a double transplant. Within 48 hours, the team was able to perform the procedure.

“A lung transplant was her only chance for survival,” Ankit Bharat, MD, chief of thoracic surgery and surgical director of the hospital’s lung transplant program, said in the news release. Organ transplants may become more common in severe cases of COVID-19, Ankit Bharat. The coronavirus affects the lungs most often, but it can also damage the heart, kidneys, blood vessels, and nervous system.

“We want other transplant centres to know that while the transplant procedure in these patients is quite technically challenging, it can be done safely,” he said. “It offers the terminally ill COVID-19 patients another option for survival.” The patient tested negative for COVID-19 before she was placed on the transplant list.

Coronavirus (COVID-19) Test

Uses: Use to detect the 2019 novel coronavirus (SARS-CoV-2) that causes COVID-19

Method: Real-Time PCR, ELISA, Qualitative Nucleic Acid Amplification, Antibody (serology) test

Category: Viral Infections

Reference: COVID-19 test by RT-PCR: Positive: RNA specific to SARS-CoV-2 detected, Negative: RNA specific to SARS-CoV-2 not detected, Inconclusive: This could be due to the low viral load in the sample. A repeat sample is recommended for confirmation

COVID-19 IgG by ELISA: Negative: 0.7 Index or less
Indeterminate: 0.8-1.0 Index 
Positive: 1.1 Index or greater

Pre-test Information: Duly filled Covid-19 clinical information form (form 44) is mandatory.

Specimen: Submit oropharyngeal & nasopharyngeal Swab/ ET secretions/ BAL / Sputum inoculated in special viral transport medium. Duly filled Covid-19 documentation as mandated by GOI is mandatory. A blood sample is drawn from a vein or is collected from a fingerstick for an antibody test in Red tube.

Storage: Refrigerated

Stability: Stability Room: 2 hrs
Stability Refrigerated: 72 hrs
Stability Frozen: 1 month

Report: 1-5 days

More details: This test is useful for the detection of coronavirus. Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). Coronavirus disease (COVID-19) is a new strain that was discovered in 2019 and has not been previously identified in humans. Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, an infection can cause pneumonia, severe acute respiratory syndrome and kidney failure. A negative result does not rule out the possibility of Covid-19 infection. Presence of inhibitors, mutations & insufficient RNA specific to SARS-CoV-2 can influence the test result. Kindly correlate the results with clinical findings. A negative result in a single upper respiratory tract sample does not rule out SARS-CoV-2 infection. Hence in such cases, a repeat sample should be sent. Covid-19 Test conducted as per kits approved by ICMR / CE-IVD / USFDA. Kindly consult referring Physician / Authorized hospitals for appropriate follow up. Also Known As Coronavirus 2019 Test SARS CoV-2 Test COVID-19 RT-PCR COVID-19 IgG, IgM antibody test SARS CoV-2 antigen test COVID-19 Ag test. Formal Name Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) RNA Detection by RT-PCR, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Antibody, Serum COVID-19 Antigen test. 

Factor VIII Assay

Uses: Order to diagnose hemophilia A, acquired factor VIII deficiency, or as part of a diagnostic workup for von Willebrand disease (VWD). Also useful for monitoring treatment in patients with factor VIII deficiency or VWD. Not recommended when screening for thrombophilia.

Method: Electromagnetic Mechanical Clot Detection

Category: Coagulation Disorders, Hematology

Reference: Normal

Age Reference Interval
0-6 years 56-191%
7-9 years 76-199%
10-11 years 80-209%
12-13 years 72-198%
14-15 years 69-237%
16-17 years 63-221%
18 years and older 56-191%

Abnormal in hemophilia >5% Mild, 1-5% Moderate, <1% Severe

Pre-test Information: Overnight fasting is preferred. Give a brief clinical history. It is recommended that patient discontinues Heparin for 1 day & Oral Anticoagulants for 7 days prior to sampling as these drugs may affect test results. Discontinuation should be with prior consent from the treating Physician.

Specimen Collection: 3 mL Whole blood in 1 Blue tube (Sodium Citrate). Mix thoroughly by inversion. Transport to Lab within 4 hrs. If this is not possible, make PPP within 1 hour of the collection as follows: Centrifuge sample at 3600 rpm for 15 min & transfer supernatant to a clean plastic tube. Centrifuge this supernatant again at 3600 rpm for 15 mins & finally transfer the supernatant (PPP) to 1 labelled clean plastic screw-capped vial. FREEZE IMMEDIATELY. Ship frozen. DO NOT THAW. Overnight fasting is preferred. Duly filled Coagulation Requisition Form is mandatory.

Storage: Critical frozen

Stability: Stability Room 4 hrs
Stability Refrigerated 4 hrs
Stability Frozen 2 weeks

Report Availability: 1-3 days

More Details: Other names that describe the test. Antihemophilic Factor (AHF), Factor VIII:C (Coagulant Portion) Coagulation Factor VIII Activity Assay,Plasma Factor VIII Activity Assay, Intrinsic Factor Proteins, Intrinsic Factors, Factor 8 deficiency test. Ageing, pregnancy, OCP use & oestrogen replacement therapy can increase Factor VIII levels.

CYFRA 21-1 (Cytokeratin 19 Fragment)

Uses: Tumor marker for diagnosing lung cancer. Monitoring the course of Non-small cell lung cancer (NSCLC) & course monitoring in Myoinvasive Bladder cancer

Method: Quantitative ELISA, Electrochemiluminescence, Immunoradiometric Assay

Category: Cancer, Oncology

Reference:  Normal < 3.30 ng/mL, Elevated > 3.30 ng/ml

Pre-test Information: Provide a brief clinical history. No special preparation required

Specimen Collection: 2 mL (0.5 mL min.) serum from 1 SST. Ship refrigerated or frozen. Allow serum specimen to clot completely at room temperature. Separate serum from cells ASAP or within 2 hours of collection. Transfer 1 mL serum to plain Red tube.

Storage: Refrigerated

Stability: Stability Room 2 hrs
Stability Refrigerated 4 weeks
Stability Frozen 2 months (avoid repeated freeze/thaw cycles)

Report Availability: Same day – 8 days

More Details: CYFRA 21–1 is a sensitive and specific tumor marker of non-small-cell lung cancer (NSCLC), especially of squamous cell subtype. It also reflects the extent of the disease and has an independent prognostic role along with performance status and disease stage in NSCLC. In addition, detection of serum CYFRA 21–1 allows for the identification of high-risk patients that may benefit from adjuvant chemotherapy and enables the early detection of progressive disease in recurrent NSCLC. Additionally, CYFRA 21–1 has been described as a useful marker for oesophagal squamous cell carcinoma and for therapy monitoring of bladder cancer. This test is not recommended for the primary diagnosis of Lung cancer. Patients receiving Biotin therapy in high doses should not be tested for at least 8 hours after the last dose. Levels greater than 30 ng/mL are highly indicative of Primary Bronchial carcinoma. Increased Levels are also found in  Non-Small cell carcinoma lung, Acute pneumonia, Tuberculosis, Interstitial lung disease, Liver cirrhosis & Renal failure.

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